title: Integration of preventing mother-to-child transmission of HIV and syphilis testing and treatment in antenatal care services in the Northern Cape and Gauteng provinces, South Africa.
abstract: BACKGROUND
  South Africa recommends universal syphilis and HIV testing in pregnancy, with prompt antiretroviral therapy or penicillin treatment for women testing positive.
  
  
  METHODS
  We used a multistage, purposeful sampling strategy to retrospectively identify clinical records from a sample (7.3%) of 32,518 women delivering from January 2005 to June 2006 at 6 public clinics in the Northern Cape and Gauteng. Descriptive analyses and logistic regression were used to assess coverage and factors related to testing and treatment of HIV and syphilis.
  
  
  RESULTS
  Of 2379 women sampled, 93% accessed antenatal care (ANC) services during pregnancy and 71% before the third pregnancy trimester. Testing during pregnancy or delivery was 74% for HIV and 84% for syphilis; testing at the first ANC visit was 41% and 71%; and infection prevalence at delivery was 14% and 5%, respectively. Of 243 women with reactive HIV tests, 104 (43%) had treatment documented (single-dose nevirapine) before delivery. Of 98 women with reactive syphilis tests, 73% had documented receipt of 1 penicillin injection and 36% had all 3 recommended injections. Multivariable analysis found women tested for syphilis were almost 4 times more likely to have had no HIV test compared with those without syphilis testing (adjusted odds ratios, 3.9; 95% confidence interval, 1.7-5.5).
  
  
  CONCLUSIONS
  Integration and provision of a package of HIV and syphilis testing at the first ANC visit and decentralizing treatments of both infections to primary care settings could increase the coverage of testing and treatment services, thus enhancing the effectiveness of current programs eliminating mother-to-child transmission of HIV and syphilis.
authors.affiliation: From the *Centers for Disease Control and Prevention, Division of Global HIV/AIDS (CDC/DGHA), Atlanta, GA; †Centers for Disease Control and Prevention, Division of Sexually Transmitted Disease Prevention (CDC/DSTDP), Atlanta, GA; ‡National Institute for Communicable Diseases of the National Health Laboratory Service (NICD/NHLS), Johannesburg, South Africa; §Gauteng Department of Health, Johannesburg, South Africa; ¶Northern Cape Department of Health, Kimberly, South Africa; and∥Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Thu-Ha
authors.initials: TH
authors.lastname: Dinh
authors.forename: Mary L
authors.initials: ML
authors.lastname: Kamb
authors.forename: Veerle
authors.initials: V
authors.lastname: Msimang
authors.forename: Muptal
authors.initials: M
authors.lastname: Likibi
authors.forename: Thabo
authors.initials: T
authors.lastname: Molebatsi
authors.forename: Thurma
authors.initials: T
authors.lastname: Goldman
authors.forename: David A
authors.initials: DA
authors.lastname: Lewis
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical; D008403:Mass Screening; D010406:Penicillins / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000517:prevention & control*; D011295:Prenatal Care / Q000379:methods*; D015995:Prevalence; D012189:Retrospective Studies; D018571:Sentinel Surveillance; D013019:South Africa / Q000453:epidemiology; D013587:Syphilis / Q000188:drug therapy / Q000517:prevention & control / Q000635:transmission*
chemical_list: D000900:Anti-Bacterial Agents; D019380:Anti-HIV Agents; D010406:Penicillins